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World J Diabetes. Dec 15, 2013; 4(6): 319-323
Published online Dec 15, 2013. doi: 10.4239/wjd.v4.i6.319
Enzymatic vitrectomy for diabetic retinopathy and diabetic macular edema
Manuel Diaz-Llopis, Patricia Udaondo, Jose Maria Millán, J Fernando Arevalo
Manuel Diaz-Llopis, Patricia Udaondo, Department of Ophthalmology, University and Polytechnic Hospital La Fe of Valencia, 46009 Valencia, Spain
Jose Maria Millán, Department of Genetics, Hospital Universitario La Fe of Valencia, 46009 Valencia, Spain
J Fernando Arevalo, Retina Division, Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD 21231, United States
J Fernando Arevalo, King Khaled Eye Specialist Hospital, Riyadh 11462, Saudi Arabia
Author contributions: All the authors contributed to this work.
Correspondence to: Manuel Diaz-Llopis, MD, Department of Ophthalmology, University and Polytechnic Hospital La Fe of Valencia, Avenida Campanar 21, 46009 Valencia, Spain. manuel.diaz@uv.es
Telephone: +34-666-530085 Fax: +34-963-606848
Received: December 27, 2012
Revised: September 7, 2013
Accepted: September 14, 2013
Published online: December 15, 2013
Abstract

The aim of this paper is to determine the role of enzymatic vitrectomy performed by intravitreal injection of autologous plasmin enzyme (APE) in the management of diabetic retinopathy and diabetic macular edema (DME). Diabetic patients with proliferative diabetic retinopathy or DME and evident posterior hyaloid adherence to the retinal surface were included. All cases were treated with an initial intravitreal injection of APE and reevaluated one month later, measuring changes in best-corrected visual acuity (BCVA), macular thickness and the status of the posterior hyaloid. A second APE injection was performed in cases with no evident posterior vitreous detachment (PVD) after the initial treatment. Sixty-three eyes were included in the present review. A complete PVD appeared in 38% of cases (24 eyes) after one injection of plasmin and the total increased to 51% (32 eyes) after the second injection, separated at least by one month. The central macular thickness improved in all cases (100%) and BCVA in 89%. Finally, in 50% of eyes with proliferative diabetic retinopathy, a high reduction of new vessels regression was observed. Enzymatic vitrectomy could be considered a good therapeutic alternative in diabetic retinopathy and macular edema.

Keywords: Enzymatic vitrectomy, Autologous plasmin, Diabetic macular edema, Diabetic retinopathy

Core tip: Diabetes mellitus might be considered as a pandemic disease with its incidence and prevalence increasing exponentially, even becoming epidemic. The aim of the present review was to analyze the clinical efficacy of the intravitreal injection of autologous plasmin enzyme in the treatment of diabetic retinopathy and diabetic macular edema and to determine the role of enzymatic vitrectomy as a therapeutic approach in such cases.